t n i o p ch
u o t
arrive
revitalize
release
Touchpoint
The time in a child’s development that precedes an appreciable leap in physical, emotional, or cognitive growth.
2
index h c r a e s re Research Framework ........................6 Research Statement ..........................7 Definitions and Keywords ................8 Annotated Bibliography .................11 Observations and Reflections ........31 Precedent Analysis ..........................36
g n i m m rogra
p
Project Goals ...................................40 Client Analysis .................................41 User Analysis ...................................43 Site Analysis ....................................44 Spatial Needs ................................. 48 Diagrammatic Analysis ...................50 Preliminary Design Considerations 54 Code Issues .....................................56
t p e c n co
t n e m p o l e v e d
Clinic Logo ...................................... 80 Branded Wayfinding Package ........ 81 Visual Anthropology ...................... 82
n o i t u l gn so
desi
Floor Plan ........................................ 86 Sections ........................................... 87 Renders .......................................... 88
3
Evidence-Based Design
The process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
4
h c r a e s e
R
Research Framework Research Statement Definitions and Keywords Annotated Bibliography Observations and Reflections Precedent Analysis
5
rk o w e Fram
ch r a e s Re
The research framework is an illustrated representation of research methods and strategies and the heirarchy of information gathering. The teal rings represent the steps of information gathering, and lead to the solution.
narrowing down ideas to arrive at a single driving concept quickly composing multiple conceptual ideas
researching the
concept to establish conceptual a clear project development direction idea conceptual mapping research
concept
identifying keywords to help in research and design
solution keywords
existing evidence
annotated bibliography researching journals to gather information to use in the evidence-based design process
precendent exploration exploring precedents to help guide the design process
6
examining the
user analysis
behavioral psychology of working psychology or healing in a hospital environment
user research
observation
observing cardiology patients and caregivers to gain firsthand knowledge of the working/healing environment
researching patient information and statistics
Resea
rch St a
“1 OF EVERY 25 PATIENTS IN THE U.S. ACUTE CARE HOSPITALS HAS AT LEAST ONE HEALTHCARE ASSOCIATED INFECTION” -Magill and Edwards (2014)
temen
The hospital is not the beginning of a patient’s road to recovery, but merely a touchpoint in the path from diagnosis to recovery. How do we create a touchpoint? First, we must provide a space for patients that supports happier, more productive hospital stays by utilizing positive distractions. Second, the design must create a streamlined space for caregivers that increases efficiency and reduces mistakes, which allows for shorter length of stays and reduces healthcare associated infections. Finally, the space must utilize technology to improve the healing process by increasing caregiver efficiency, and provide patients with positive distractions. Research has shown that positive distractions within a healthcare environment can significantly improve the patient’s recovery process. What is a positive distraction? A positive distraction is anything that distracts the patient in a positive way. Chaudhary et al (2004), have proven that positive distractions can also reduce or prevent extended length of stay for patients. Providing patients with views of nature, or even with naturebased artwork has been shown to relax as well as relieve pain. In a study done by Pati (2011), pediatric cardiology patients responded positively to nature scenes played in a loop. The content provided the distraction while the switching of the photos created a sense of anticipation. Family members are an excellent positive distraction for patients. Chaudhary (2004) describes social support as a crucial element in the healing process. Allowing family members to have their own comfortable environment within the hospital space helps reduce their anxiety, which gives them the opportunity to focus on their loved one. Reducing the number of staff errors can also reduce or prevent extended length of stay. Same-handed patient rooms are rooms that have identical configurations. This reduces mistakes from caregivers, especially in emergency situations. Standardization allows caregivers the opportunity to instinctively know where tools are placed, creating a second nature routine that saves vital time in emergency situations (Stichler, 2012). Technology, such as point of care charting, also reduces mistakes that may affect the patient’s care (Duffy et al., 2010). According to Magill and Edwards (2014), the number one cause of extended length of stays are healthcare associated infections. HAI’s are infections that develop in a healthcare setting unrelated to the patient’s condition. Approximately 1 in 25 inpatients in the U.S. develop infections (Pittet, 2000). These infections can be spread through pathogens in the air, or more commonly by contact. Choudhary et al. (2004) describe several design solutions to reduce the number of infections; perhaps the easiest is providing hand-washing stations for doctors, nurses, and family members. A hospital is just a touchpoint on a patient’s long journey. Because patients spend a short amount of time in the hospital, it is imperative to design spaces that promote high quality of care while preventing extended length of stay. This goal can be accomplished by reducing the number of healthcare associated infections, reducing caregiver errors while increasing efficiency, providing positive distractions for patients and incorporating technology into the healing process.
t
7
s n o i t i efin
D
ADA Accessible Design
State and local government facilities, public accommodations, and commercial facilities that are designed to be easily accessible for individuals with disabilities.
Americans With Disabilities Act (ADA)
Legislation passed in 1990 that prohibits discrimination against people with disabilities. Under this Act, discrimination against a disabled person is illegal in employment, transportation, public accommodations, communications and government activities.
Anxiety
A feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
Bariatrics
A branch of medicine that deals with the treatment of obesity.
Cardiology
The branch of medicine that deals with diseases and abnormalities of the heart.
Centralized Nursing Station
One central nursing station that serves all caregivers in the entire unit.
Cerebrovascular Disease
Disease of the blood vessels supplying the brain.
Computed Tomography (CT or CAT scan)
An x-ray technique that uses a computer to create cross-sectional images of the body.
Congenital Heart Disease
Malformations of heart structure existing at birth; deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs.
Coronary Heart Disease
Disease of the blood vessels supplying the heart muscle
Decentralized Nursing Station
Multiple nursing stations that are spread throughout the unit
Echocardiogram
A test of the action of the heart using ultrasound waves to produce a visual display, used for the diagnosis or monitoring of heart disease.
Echocardiography
8
A method of studying the heart’s structure and function by analyzing sound waves bounced off the heart and recorded by an electronic sensor placed on the chest. A computer processes the information to produce a one-, two- or three-dimensional moving picture that shows how the heart and heart valves are functioning.
Defin
itions
Evidence-Based Design (EBD)
The process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
Headwall
Prefabricated surface mounted or wall-recessed units used to organize the utility services (e.g., electrical, gas, vacuum) and devices at the head of the patient’s bed.
Healthcare
The maintenance and improvement of physical and mental health, especially through the provision of medical services.
Healthcare Associated Infection (HAI)
Heart
HIPAA
A localized or systemetic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s). There must be no evidence that the infection was present or incubating at the time of admission to the acute care setting.
A hollow muscular organ of vertebrate animals that by its rhythmic contraction acts as a force pump maintaining the circulation of the blood
The federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information ad help the healthcare industry control administrative costs.
Holter Monitor
A portable device for recording heartbeats over a period of 24 hours or more.
Intensive Care Unit (ICU)
Specialized section of a hospital that provides comprehensive and continuous care for persons who are critically ill and who can benefit from treatment.
Intravenous (IV)
Existing or taking place within, or administered into, a vein or veins. “an intravenous drip”
Length of Stay
A term to describe the duration of a single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge. However, persons entering and leaving a hospital on the same day have a length of stay of one.
Magnetic Resonance Imaging (MRI)
A technique that produces images of the heart and other body structures by measuring the response of certain elements (such as hydrogen) in the body to a magnetic field. MRI can produce detailed pictures of the heart and its various structures without the need to inject a dye.
9
s n o i t i efin
D
Mirror Image Room
Rooms share wall that accommodates their headwalls, so they are reflections, back-to- back mirror images of each other.
Open Heart Surgery
Surgery in which the heart is exposed and the blood made to bypass it.
Patient and Family Centered Care
An innovative approach to the planning, delivery and evaluation of heal care grounded in mutually beneficial partnerships among health care providers, patients, and families.
Pediatrics
A branch of medicine dealing with the development, care, and diseases of children. The age range is typically from 0 to 18 years old.
Pediatric Intensive Care Unit (PICU)
An area in a hospital specializing in the care of critically ill infants, children, and teenagers.
Peripheral Arterial Disease
Disease of blood vessels supplying the arms and legs.
Point of Care Documentation
The process of documenting relevant patient care information at the time and place (testing area, exam room) it is collected.
Positive Distraction
Anything that distracts patients and family members in a positive way.
Registered Nurse
A nurse who has graduated from a college’s nursing program or from a school of nursing and has passed a national licensing exam.
Same Handed Patient Room
The headwalls do not share a wall. They are always positioned on the same side of the patient room
Tension
Mental or emotional strain.
Touchpoint
The time in a child’s development that precedes an appreciable leap in physical, emotional, or cognitive growth.
Welfare
10
Statutory procedure or social effort designed to promote the basic physical and material well-being of people in need.
y h p a liogr
Anno
b i B d tate
The annotated bibliography provides the backbone for the entire project. Gathering information from well respected sources, the annotated bibliography organizes the research in a way that is easily understood, streamlining the evidence based design process. The research is broken up into nine different categories. Environment ....................... 12 Reducing HAI’s ................... 15 Room Configurations .......... 17 Positive Distractions ........... 18 Technology ......................... 19 Color Theory ....................... 21 Nursing Stations ................. 23 Care Models ....................... 26 Rooming-In ......................... 29
11
t n e m n o r i v n E
Role Of The Physical Environment In The Hospital Of The 21st Century
• How can healthcare design improve the patient experience and reduce healthcare acquired infections? • The physical environment is linked to patient and staff in four areas o Reduce staff stress and fatigue and increase effectiveness in delivering care • Improve Staff Health and Safety through Environmental Measures • Reduce noise levels • Reduce high intensity lighting • Design patient beds to and nurses stations to reduce nurse back stress and fatigue • Improve air quality • Increase Staff Effectiveness, Reduce Errors, and Increase Staff Satisfaction by Designing Better Workplaces • Nurses who work in radial units instead of corridors are able to more closely monitor patients, and walk less reducing fatigue and allowing for more patient interaction • Decentralization of nursing stations as well as supplies reduces nurses walking considerably • Design layouts to best suit work patterns and flow o Improve patient safety • Reduce Healthcare Acquired Infections • Transmission of infection to patient happens through airborne and contact transmission routes • Infection rates are reduced when: o Air quality is improved o Patients are in single rooms o There are easily accessible alcohol based hand-rub dispensers or hand-washing sinks o Increase hand washing compliance which reduces contact contamination • Reducing Medical Errors •Three environmental factors affect medication errors: lighting, distractions, and interruptions o The higher the lighting levels the less mistakes were made • Reduce transfer of patients between rooms • Room transfers leads to delays, communication loss among staff, information loss, and confusion due to changes in room • Reducing transfers also can shorten patient stays and saves staff time • Reduce Patient Falls • Patients who fall incur physical injuries, psychological effects, and have greater lengths of stay • Most patients fall in the bedroom, and then the bathroom • Transfers to and from the bed cause 42.2% of patient falls • Poor design is often the reason for falls o Slippery floors o Inappropriate door openings o Poor placement of rails and accessories o Incorrect toilet and furniture heights
12
Enviro
nmen
t
• Many falls occur when patients try to get out of bed unassisted or unobserved • Bedrails are ineffective for reducing falls and may actually increase the severity of the fall injury • Improve Patient Confidentiality and Privacy • Confidentiality is compromised by caregivers talking in spaces where they are overheard by patients or other people • Providing spaces for private conversations greatly reduced the number of these confidentiality breeches • Patients in single rooms were more apt to share information because they felt they had more privacy. o Reduce Stress and Improve Outcomes • Reduce Noise • Hospitals are generally noisy because of numerous often unnecessary sources, and environmental surfaces are hard and sound reflecting. • Reduce sound by installing sound absorbing ceiling tiles, eliminating or reducing noise sources, and having single rooms rather than multi bed rooms • Noise has been shown to decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep • Improve Sleep • Reduce noise • Provide single bed rooms • Reduce Spatial Disorientation • Provide good wayfinding • Install easy to read signs and consistent verbal directions • Improve Administrative and Procedural Information • Mail out maps prior to visit for review • Improve External Building Cues • This is the first point of contact patients have with their hospital experience • Provide patients and their family with clear signage and directions • Reduce Depression • Light, both artificial and natural can improve depression symptoms as well as length of stay in patients • People in brightly lit rooms have s shorter length of stay compared to patients in dull rooms • Provide Nature and Positive Distraction • Distractions can be music, companion animals, laughter or comedy, certain art and nature • Stressful or negative emotions such as fear or anger diminish when pleasant feelings increase • Visual exposure to nature reduces stress and pain • TV monitors playing nature scenes have been shown to be more successful at reducing stress than TV shows • Gardens can provide an escape, reduce stress, and provide social support
13
t n e m n o r i v n E
• Art in Healthcare Environments • Representational nature art has been shown to be effective • A majority of patients responded negatively to abstract art • Provide Social Support • Providing comfortable accommodations for family and friends can greatly impact the success of the patient’s healing process • Improve Communication with Patients • Good communication can reduce patient and family anxiety o Improve overall healthcare quality • Provide Single Bed Patient Rooms • Reduce Length of Stay • Evidence Based Design helps reduce the chance of infection which reduces length of stay • Patients like light and views to nature • Increase Patient Satisfaction with Quality of Care • An environment that is comfortable, aesthetically pleasing, and informative can relieve stress and increase satisfaction of care • Patients in well designed, well decorated rooms rate their experiences higher than those in standard rooms Choudhary, R., Joseph, A., Quan, X., Ulrich, R., & Zimring, C. (2004). Role of the physical environment in the hospital of the 21st century. Retrieved September 9, 2014, from https://www.healthdesign.org/chd/research/role-physical-environment-hospital-21st-century
14
Reduc
ing H
Improving Compliance With Hand Hygiene in Hospitals
AI’s
• Hand hygiene is considered to most important measure to reduce the transmission of nosocomial pathogens in healthcare settings • Compliance with hand washing policies is usually around 50% Why? o Hand hygiene agents cause skin irritation and dryness o Patient needs take priority over hand hygiene o Glove use dispenses with the need for additional hand hygiene o HCW (Healthcare Worker) has inadequate knowledge of guidelines or protocols for hand hygiene; there is lack of role models (superiors or peers); o There is lack of recognition of the risk of cross-transmission of microbial pathogens; o Forgetfulness • How to improve compliance? o Education o Routine observation and feedback o Making hand hygiene possible, easy, and convenient o Making alcohol-based hand rub available (at least in high-demand situations) o Patient education o Reminders in the workplace o Administrative sanctions and rewards o Change in hand-hygiene agent (but not in the winter) o Promote and facilitate healthcare worker hands’ skin care (lotions) o Maintain an institutional safety climate o Enhance individual and institutional self-efficacy o Avoid overcrowding, understaffing, and excessive workload Pittet, D. (2000). Improving compliance with hand hygiene in hospitals. Infection Control and Hospital Epidemiology, 21(6), 381-386. Retrieved September 6, 2014, from http://www.jstor.org/stable/10.1086/501777
Facility Design and Healthcare-Acquired Infections: State of the Science
Design Solutions in Healthcare Environments • HAI’s affect 1 in 20 hospitalized patients in the United States • There is evidence that patients who are placed in a room previously occupied by a patient with MRSA, vancomycin-resistant enterococcus, or multidrug-resistant organisms (MDROs) are at greater risk for acquiring the infection • Although expensive, UV germicidal irradiation (UVGI) is an effective surface decontaminant • UVGI is effective only on surfaces directly exposed to the light. If the pathogen is tucked away in seams of chairs, countertops made of porous materials, or crevices in bedside tables, the UVGI light may not be effective in killing the C difficile spores. • Use seamless surfaces on non porous countertops, equipment and furniture to avoid this • Infection can be transmitted from all high touch surfaces like light switches, countertops, and ESPECIALLY manual hand gel dispenser • Copper may have antimicrobial properties • Avoid Carpets in patient rooms- They are harder to clean and support the growth of C difficile spores and other fungal spores and pathogens
15
’s I A H ced
Redu
• Avoid using faucets that dispense water directly over a drain hole. This can create an aerosol of contaminated water; offset the drain hole to avoid this. • Electronic faucets have been noted to have a higher incidence of Legionella • Avoid decorative fountains; they are at a high risk for Legionella. Should they be used make sure the water is cleaned regularly to reduce microbial growth • Strategically locate hand washing sinks in the direct path from the door to the patient • Mesh materials are harder to clean and increase the potential for transmission of pathogens Stichler, J. (2014). Facility design and healthcare-acquired infections: State of the science. Journal of Nursing Administration, 44(3), 129-132. Retrieved September 5, 2014, from OvidSP.
The Role of the Hospital Environment the Prevention of Healthcare-Associated Infections by Contact Transmission
• Avoid Carpets, can spread infection from patient to patient • Physical barriers, such as single patient rooms, can potentially decrease transmission of pathogens by providing spatial separation • Curtains are considered “high touch” surfaces by the CDC they can be contaminated with MRSA, VRE, and C. difficile. They should be avoided, but if they must be used they must be cleaned regularly Steinburg, J., Denham, M., Zimring, C., & Et al. (2013). The role of the hospital environment the prevention of healthcare-associated infections by contact transmission. Health Environments Research & Design Journal, 7, 46-73. Retrieved September 4, 2014, from https://www.herdjournal.com/article/role-hospital-environment-prevention-healthcare- associated-infections-contact-transmission
Multistate Point-Prevalence Survey of Health Care–Associated Infections
• 1 in 25 inpatients in U.S. acute care hospitals has at least one health care-associated infection • Overall, 169 of 394 non–surgical-site infections (42.9%) developed during or within 48 hours after a stay in a critical care unit; 167 (42.4%) developed during or within 48 hours after a stay in a non-nursery ward. • Pneumonia and surgical-site infection were most common, followed by gastrointestinal infection, urinary tract infection, and primary bloodstream infection. • C. difficile was the most common pathogen. • Infections other than those associated with central catheters, urinary catheters, and ventilators account for the majority of the U.S. burden of health care–associated infections. Magill, S., Edwards, J., et al. (2014). Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), 1198-1208. Retrieved September 10, 2014, from New England Journal of Medicine.
16
Room
Confi gurat
Same-handed Patient Room Configurations: Anecdotal and Empirical Evidence
ion
• Same-handed rooms are private rooms that are all identical without touching headwalls the configuration is standardized so each room and the equipment is instinctive for staff. All medical gases, equipment, and supplies are located in the same place on the hallway side of the room. • Mirror-image rooms are private rooms that are mirror images of each other so the headwalls for two rooms are on the same wall. The medical gases, equipment, and supplies are located on the left side in 50% of the rooms and on the right in 50%. • Same-handed may decrease patient care errors because the headwall and supplies are in the same place, and in an emergency staff will have to spend less time recalling the location of the equipment • All hospital rooms should have the following safety features: o Clear line of sight from a nurse documentation area outside the room, o Barrier-free access from the patient bed to the bathroom, o Hand-washing sinks located adjacent to the entry door, o Adequately sized bathroom doors to accommodate the patient, caregiver, and a mobile intravenous (IV) pole. • It may not actually matter if the rooms are same-handed or mirrored, but what is important is that they are all standardized. Hospital rooms may or may not vary in design, but patients and their conditions will always vary. • The author states that the standardization of the headwall is the most important that the room orientation or mirror vs. same handedness. • In a study cited in this article patients in same handed rooms did say there were significantly quieter, and which allowed them to have better sleep quality than in the mirrored rooms. • The study found that in same-handed rooms most nurses approached the patients on their right side. • Patients in this study who claimed they had nurses approach them on the right side also had fewer near falls (r = -0.56, P < .05), This may be because 88% of North Americans are right handed. • Nurses reported that there was better organization of workspace at the patients’ bedsides for same-handed rooms. • This article makes the conclusion that rather than argue for same-handed vs. mirrored rooms, the most important part of patient room design is standardization. John Hopkins has reduced healthcare acquired infections by 95% by using a checklist that has standardized care. Standardization of care is an effective way to reduce patient care errors. McCullough, C., & Stichler, J. (2012). Same-handed patient room configurations: Anecdotal and empirical evidence. Journal of Nursing Administration, 43(3), 125-130. Retrieved September 1, 2014, from OvidSP.
17
s n o i t c istra
D e v i t i Pos
Positive Distractions
Dental Clinic: • Children responded the most to a TV monitor with both picture and sound. • This reduced their “people watching” by 15.52% Cardiac Clinic • Children’s calm behavior increased 8.96% when they had a positive distraction • Children responded most positively to a TV monitor with only picture, no sound an increase of 20.17% • Art or nature slide shows were played in 10 minute increments, followed by a blank screen for an additional 10 • The slide shows created anticipation for the viewers that held their attention until the end • This reduced their “people watching” by 12.09% • They also responded positively to a toy Pati, D. (2010, March 11). Positive Distractions. Retrieved September 5, 2014, from http://www.healthcaredesignmagazine.com/article/positive-distractions
Better Use of Lighting in Hospital Rooms May Improve Patients’ Health
• Patients in this study found they had trouble sleeping within a hospital environment. Researchers believed it was because of the 24-hour exposure to consistent, low lighting levels. • Patients responded more positively to lighting when it mimics the natural variations of the day. They felt less fatigue, which led to less pain. • Installing daylight monitors may help Bernhofer, E. (2013). Better use of lighting in hospital rooms may improve patients’ health. Journal of Advanced Nursing, 70(5), 1164-1173. Retrieved September 3, 2014, from Wiley Online Library.
18
Techn o
logy
Point of Care Documentation Impact on the Nurse-Patient Interaction
• Point of Care documentation happens when a nurse documents patient findings on a computer while talking to the patient. • This provides all with instant access to all information on a patient, which increased efficiency and decreases the chance for delays in treatment. • Nurses also have more time to spend with the patient instead of charting outside of the room. • This was initially adopted to improve patient safety by eliminating paper medical records, which could get lost and cause errors, and illegible handwriting, which also caused errors. • While this method is effective, it takes some of the interpersonal communication out of the nurse/patient relationship, which is vital to patient care. Nurses have less eye contact and less discussion with their patients and were distracted more easily. This may also lead to errors. Duffy, W., Kharasch, M., & Du, H. (2010). Point of care documentation impact on the nurse- patient interaction. Nursing Administration Quarterly, 34(1), E1-E10. Retrieved September 8, 2014, from OvidSP.
Innovative System Offers New Way to Track Hand Washing Compliance and Prevent the Spread of Hospital Infections
• Biovigil Hand-washing System • Reduces Healthcare Associated Infections • Assures patients and hospital management that ALL caregivers are washing their hands. This information is recorded and is placed on the caregivers record • How it works: Upon entering the room the nurse’s badge changes colors and then chirps to remind the nurse that hand hygiene is required. Once hands are sanitized, the badge illuminates a bright green hand symbol which signals to all that the hands are clean. During the past two months, staff hand-washing compliance on two test units at the hospital are now routinely maintained near 100 percent (99% and 97%), a level never before attained by a hospital, especially with this type of visibility and precision. • When going in or out of a patient’s room, the badge cycles through a series of color changes from green to flashing yellow to flashing red. Green means clean. To return the badge to the green (clean) status, a staff member simply places their sanitized hands close to the badge as they are drying – proudly called “pledging the badge.” Hands must be cleaned by using an alcohol based cleaner Innovative system offers new way to track hand-washing compliance and prevent the spread of hospital infections. (2013, June 23). Retrieved September 8, 2014, from http://www. ssmhealth.com/news/biovigil_ssm_st_mary/
Simple Solutions for Improving Patient Safety in Cardiac Monitoring—Eight Critical Elements to Monitor Alarm Competency
• Alarm signals are designed to alert healthcare professionals to threats in patient safety, but the sheer number of these alarms going off can create alarm fatigue and is a safety concern to patients. • Use of alarm signals is especially prevalent in cardiology. • The alarms are often set to go off for non-threatening conditions such as “informational” arrhythmia alarms, and premature ventricular contractions.
19
y g o l o Techn
• The arrhythmia alarms at the University of Pittsburgh Medical Center Cardiology unit would signal an average of 83 alarm signals per day, per patient which averages to approximately one alarm going off every 96 seconds. When reviewed over 10 days an average of 871 non-life threatening/non actionable alarm signals per day in an 18-bed medical cardiology unit. • Nurses were not able to respond quickly to all alarms and were constantly pulled away from patients. It was also too hard to differentiate the alarm signals from life threatening or non-life threatening. • The alarms constantly going off causes unnecessary stress for patients. • The hospital then switched all unnecessary alarms off and the rings were customized based on room and how life threatening the situation was. • This reduced alarm signals by approximately 80% and allowed for a calmer, quieter environment conducive to healing. Scott-Allen, J., Hileman, K., & Ward, A. (2013, March 1). Simple solutions for improving patient safety in cardiac monitoring— eight critical elements to monitor alarm competency. Retrieved September 11, 2014, from http://www.aami.org/htsi/SI_Series/Alarm_ Competency _White_Paper.pdf
20
Color
Theor
y
Functional Color and Design in Healthcare Environments
• Ninety-five percent of all individuals who are asked how to alleviate a stressful situation respond that they are most comforted and soothed by being outdoors. • To reduce stress and pain designers should add strong references to nature in healthcare environments. • Color and natural materials can affect physiological responses in patients. Wood has been shown to lower sympathetic nervous system activation and patient stress. • White walls symbolized cleanliness in the 20th century, now seen as sterile. • Colors can create visual serenity for those that are ill and visual stimulation for those that are healing. • Use a balanced color palette with variety that encourages health and well-being • Limit monochromatic color schemes because they may appear institutional • Strong primary colors can create visual fatigue • A full spectrum of colors should be used in to promote health. The colors can have a large representation, or a small one. • Do not use strong colors on the headwall because it may reflect on the patient and affect diagnosis • Create a residential style that takes some of the hospital feeling away. • For pediatrics use clear and light colors to add brightness. • Bright colors may be used to create a fun, approachable environment • Yellow o Yellow is a warm or hot color that comes from larger wavelengths on the color spectrum o It has the feeling of advancing towards the viewer o Yellow: • Conveys Lightness • Encourages Spontaneity • Expresses Caution • Indicates Innovation • Implies Free Spirit • Inspires Creativity • Offers Zest and Joyfulness • Radiates Warmth • Raises Alert Level • Teal o Teal is a cool or cold color, the hues come from shorter wavelengths of the spectrum o It has the feeling of receding away from the viewer o Teal: • Balanced Appeal • Calming Influence • Conveys Unique Quality • Communicates Gracefulness • Expresses Refinement • Inspires Harmony • Nurtures Sensitivity • Refreshing Atmosphere • Renews Spirit • Soothing Demeanor • Suggests Healing
21
y r o e h lor T
Co
• Green o Green is a cool or cold color, the hues come from shorter wavelengths of the spectrum o It has the feeling of receding away from the viewer o Green: • Enhances Concentration • Facilitates Judgment • Nurtures Relaxation • Offers Balance • Promotes Security • Provides Refreshing Atmosphere • Renews Spirit • Suggests Healing • Blue o Blue is a cool or cold color, the hues come from shorter wavelengths of the spectrum o It has the feeling of receding away from the viewer o Blue: • Calming Spirit • Combats Tension • Cultivates Conservatism • Offers Serenity • Promotes Thoughtfulness • Promotes and Provides Introspection • Soothing Nature • Supports Relaxation • Underscores Devotion Allan-Novak, C., & Richardson, B. (2013, December 1). Functional Color and Design in Healthcare Environments. Retrieved September 10, 2014, from http://continuingeducation.construction.com/article.php?L=222&C=928&P=1
22
Nursi
ng St
ations
Centralized vs. Decentralized Nursing Stations: An Evaluation of the Implications of Communication Technologies in Healthcare
• “Nurses are the largest and most reliable staff population within the healthcare system” • Patient satisfaction is influences with nurses are able to collaborate • High stress levels in nurses are associated with lower quality of care. Environmental factors can affect stress levels. • Two technological innovations that are changing the practice of nursing and communication are: electronic health records, and computerized physician/provider order entry and clinical decision support • Communication technologies affect how the nurses practice, and how they utilize their environment • Technology has been shown to help increase efficiency and reduce medical errors by utilizing it to access patient records, drug information, and blood test results. Technology provides tools that help improve patients and providers experiences • Nurse Call Systems (NCSs) give patients a quick communication tool • Wireless communication technologies with audio and visual have been shown to improve nurses’ responses to patient falls, as well as reduced cell phone usage with nurses and increase efficiency. • Social media has also been incorporated into nursing practices • Technology improves quality and safety, increases efficiency in healthcare, and facilitates clinical decision-making. • A nursing station includes the unit’s reception, patient records, and charting areas. This is the nurses primary workstation • Centralized Nursing Stations o Supports interpersonal communication and collaboration between nurses, as well as other disciplines such as techs and doctors. o Help to create a boundary from public to private areas o Helps to protect the privacy and confidentiality of patient information that goes through a nursing station o They do discourage communication through technology o The frequency of interruptions can lower the quality of medical care which can result in medical errors • Decentralized Nursing Stations o These distributed nursing stations put the nurses closer to the patients, but separate the nurses from each other reducing the number of interactions between them. o They decrease nurses walking time o Allow nurses to visit their patients more frequently o Increases team communication with the staff o Technology has reduced the need for centralized stations and have increased the need for decentralized stations • This study tracks how nurses use technology to communicate in centralized vs. decentralized stations o The study found that there was no statistically significant difference in the two types of station in regards to the use of communication technologies. o Nurses in both types of stations used the face to face communication methods to technology methods, but were not opposed to utilizing technology
23
s n o i t g Sta
n i s r u N
Alkazemi, M., & Bayramzadeh, S. (2014). Centralized vs. decentralized nursing stations: An evaluation of the implications of communication technologies in healthcare. Health Environments Research & Design Journal, 7(4), 64-80.
Centralized vs. Decentralized Nursing Stations: Effects on Nurses’ Functional Use of Space and Work Environment
• This study explored how nursing station design affected nurses’ use of space, patient visibility, noise levels, and perceptions of the work environment. • This study found that time spent away from the patient (phone, computer, and paper administration) was higher in centralized units vs. decentralized units • Decentralizing nursing stations decreased these tasks • Decentralized units felt less connected to their colleagues, while social interactions were much higher in the centralized units. • Social support may help the caregivers psychologically by increasing their sense of control, and helping to manage stress. • Sound levels were the same in both centralized and decentralized stations • Communication and contact between nurses and families occurred most often in patient rooms and corridors rather than nursing stations. • A more family friendly setting may reduce anxiety levels among patients and staff. • Nurses indicated in the study that separating spaces in stations for charting and other tasks increased efficiency • A reception desk to assist family and visitors minimized interruptions and helped provide a separation for private and personal space. • While there are pros and cons to both of these stations, the answer may lie in a hybrid model with decentralized nursing stations combined with centralized meeting rooms for staff providing areas for computer duties as well as collaboration. Bunker-Hellmich, L., Morelli, A., O’Neill, M., & Zborowsky, T. (2010). Centralized vs. decentralized nursing stations: Effects on nurses’ functional use of space and work environment. Health Environments Research & Design Journal, 3(4), 148-157.
Centralized and Decentralized Nurse Station Design: An Examination of Caregiver Communication, Work Activities, and Technology
24
• The advantages of decentralized work stations outweigh the disadvantages in regards to patient care • In decentralized stations nurses spend less time in medication and supply rooms and more time with patients allowing for more monitoring of the patients condition as well as their safety • Patients perceived a quicker response to calls in the decentralized unit • Nurses did miss the lowered contact between other caregivers • When implementing reliable nurse locater systems, less time was spent trying to locate team members, as well as increased communication opportunities • This technology provided information to help evaluate clinical processes and uncovered inefficiencies • This article states that RN’s and ergonomic professionals should be asked to help in the design process to create environments that reduce stress for caregivers Gurascio-Howard, L., & Malloch, K. (2007). Centralized and decentralized nurse station design: An examination of caregiver communication, work activities, and technology. Health Environments Research and Design Journal, 1(1), 45-57.
Nursi
ng St
ations
Effects of Nursing Unit Spatial Layout on Nursing Team Communication Patterns, Quality of Care, and Patient Safety
• Environments that support teamwork provides greater job satisfaction, quicker and more patient-sensitive service, and delivers more clinically effective, cost effective healthcare • Inter-professional communication and collaboration can improve effectiveness and efficiency of healthcare delivery • Centralized nursing stations (single nursing station throughout a patient unit) are traditional • Decentralized nursing stations (more than one nursing care station throughout the unit) are becoming more popular • Hybrid nursing stations have a larger central unit with several touchdown areas throughout the space • Decentralized Units o Have been found to reduce communication o RN’s had 40% more visits to patient rooms, responded quicker to calls o Do not reduce noise or improve patient visibility • Both centralized and decentralized nursing stations have pros and cons, but a hybrid station tries to combine the collaboration from the central model and the flexibility and patient centered decentralized model to create the ideal work environment • Advantages of the decentralized model outweigh the disadvantages if there are more staff involved and more effort from caregivers to initiate the conversation Hua, Y., Becker, F., Wurmser, T., Bliss-Holtz, J., & Hedges, C. (2012). Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. Health Environments Research and Design Journal, 6(1), 8-38
25
ls e d o M e r a C
Implementing Patient & Family-Centered Care: Pt I – Understanding the Challenges
• In older care models patients and their families would simply accept anything that caregivers told them, now families and patients are asking to be actively involved in their healing process • Pediatrics is leading the charge for patient and family centered care • “Patient and family centered care…is an innovative approach to the planning, delivery and evaluation of heal care grounded in mutually beneficial partnerships among health care providers, patients, and families.” • Core Concepts o Dignity and Respect • Caregivers should listen to and respect patient and family perspectives and choices • Patient and family beliefs and values are incorporated into their care o Information Sharing • Caregivers should share information with the family and patient in a timely fashion so they can participate in decision making o Participation • Family and patients should participate in the care and decision making o Collaboration • Caregivers, patient, and family should collaborate together for the best method of care • Barriers o Outdated procedures and policies may make it hard to implement changes o Individual nurses may want to implement these policies, but are not allowed to so they make decisions that are not fully consistent with hospital policies, or patient and family centered concepts o Attitudinal Challenges • Caregivers may think that families will be in the way • Make unreasonable requests • Question caregiving skills • Take up too much time • Overhear private information and violate HIPAA • Have unrealistic expectations o Organizational Challenges • Patients and families may not be seen as partners • A hospital may not fully integrate all patient and family centered care concepts • This may be perceived as a trend and not taken seriously • Leaders are not committed to this model of care • Lack of accountability • No incentives • Successful Implementation o Overcoming attitudinal and organizational challenges combined with an effort to live these core concepts leads to successful implementation o Providing the proper education can go a long way, as well as holding staff members accountable
26
Care
Mode
ls
o Leaders need to lead the team towards successful implementation o Nurses can help push for organizational change and implement these procedures in everyday life Abraham, M., & Ginn Moretz, J. (2012). Implementing patient- and family-centered care: Part I – understanding the challenges. Pediatric Nursing, 38(1), 44-47.
Building Patient-Centeredness: Hospital Design as an Interpretive Act
• The physical design of the hospital has as much to do with patient-centered care that the actual care does • Designs that allow for an “onstage, offstage” customer service model can help provide patient centeredness • Managerialism and consumerism are growing trends in healthcare taken from the hospitality industry. These can help with patient centered • The author wants to correct the dehumanization of contemporary medicine • Patients prefer homelike environments with natural light and nature this promotes a sense of normalcy • Private patient rooms help with patient control Bromley, E. (2012). Building patient-centeredness: Hospital design as an interpretive act. Social Science & Medicine, 75(6), 1057-1066. Retrieved September 6, 2014, from http://www.sciencedirect.com/science/article/pii/S0277953612004054
One Stop Post Op Cardiac Surgery Recovery--a Proven Success
• One Stop Post Op is a process that integrates all levels of care for a cardiac patient. • Cardiac patients often go through step down phases of care from ICU to unmonitored beds. • Moving the patients so frequently can cause inefficiencies, and can disconnect the patient from the caregivers with each caregiver having to relearn the patient’s care requirements and special needs. • In the One Stop Post Op model allows the patient to stay in his or her room throughout their entire length of stay and the service levels change to accommodate their needs. The equipment changes to meet their needs. • In this model rooms are designed to meet every level of acuity. • The environment is designed to look like a hotel room with comfortable furnishings and distractions that are conducive to recovery. • This model reduces costs and inefficiencies associated with patient transfers. • This streamlines the healing process, because caregivers and patients can get to know each other on a more personal basis, which can help in the healing process. • Each caregiver is trained in both pre and postoperative open-heart surgery care, creating a very flexible staff and allowing for rapid intervention and monitoring. • Key Benefits o Patient, Nurse, and Physician Satisfaction • Higher nurse retention rates o Lowered Length of Stay • Because these care teams are multifunctional, they are each able to monitor and react to the patient’s needs immediately, reducing delay. o Operational and Staffing Cost Efficiencies
27
ls e d o M e r a C
o Continuous communication • Dialogue between nurses and physicians, and caregivers and families is imperative in this model. o Active Family Involvement • This model supports open family visiting hours and encourages family to be active members of the healing process o Employee Ownership • Creates bonding opportunities for staff and patients o Clinical Expertise • Nurses in cardiovascular units are highly specialized and trained to react to all complications creating a faster recovery process. Pandolph, P., & Joyce, L. (2001). One Stop Post Op cardiac surgery recovery--a proven success. The Journal of Cardiovascular Management, 12(5), 8-16. Retrieved October 4, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/11596524?report=abstract
28
Room
ing In
Patient and Parent Sleep in a Children’s Hospital
• Sleep can improve immunity and healing in patients as well as the mood and functioning of the parents • Nurses must work with patients and families to help with sleep quality and quantity • Having a parent in a child’s hospital room can decrease patient and parent stress and anxiety as well as increase parental self confidence • Sleep Disruptions come from: o Noise from other patients o Medical equipment o Hallway conversations o Uncomfortable sleeping arrangements such as a chair • It is important for parents to get plenty of sleep so they can be an advocate for their children’s care • School age children in this study had later bedtimes and experienced shorter sleep • Adolescents had later wake times and longer sleep times • Parents reported more night wakings and poorer sleep at a hospital than at home • Noises such as alarms and doors were found to be bothersome • Nurses can make the biggest difference in improving sleep quality • Design can also help with utilizing slow release door mechanisms, and anticipating alarms with quieter volumes • Worries and anxieties can disrupt sleep o Homesickness o Worrying about school o Worrying about being sick • Parents sleep disruptions stemmed from stress about their child’s health. In this situations nurses should help find the parents a psychosocial care provider • Updated parents on the child’s health status can also reduce worried • Providing children with activities close to home life can diminish homesickness • Nurses should advocate for vital sign checks less frequently to prevent night wakings • Pain disrupts sleep which then causes more pain so more pain management (pharmacological or behavioral) must be utilized when trying to sleep • Provide comfortable beds and comforts such as pillows and blankets • In two person families alternate days at the hospital to catch up on sleep • Parents must get good quality sleep to make decisions about their child’s health Meltzer, L., Finn Davis, K., & Mindell, J. (2012). Patient and parent sleep in a children’s hospital. Pediatric Nursing, 38(2), 64-71.
Rooming-in: An Update
• The bond between children and their mothers is very strong, and may actually assist in the healing process • Rooming in (staying in the same room as your child) began in maternal and pediatric units at the request of the families • Rooming in and Nursery o Three types of Nursery Care Facilities • Completely separated rooms between mother and baby • Mothers can only spend small scheduled increments of time with their baby • The whole course of care is done in the babies room
29
In g n i oom
R
• Partial rooming in • Mothers can spend larger amounts of time with their child • They must leave at some points because the procedures are also done in the room • Complete Rooming In Care • Baby and mother are in the same room for the entire duration of their stay • All care for mother and baby are done inside the same room oRooming in care has been shown to promote long-term breastfeeding which increases health benefits for mothers and babies o Allows for more skin to skin contact which leads to better breastfeeding and diminishes pain responses in vaccinations o Close contact in the sensitive period (2 hours after birth) may have a positive effect on mother infant interaction • Rooming-In and NICU o The NICU is the only place where the mother is not considered and essential member of the care team, and may even endanger her infant o It is a high tech nursery where specialists care for preemies o The mother must be well enough to come visit her baby o NICU has been slower to adapt to the rooming in model because the design of the units did not provide space for this o Private NICU rooms allow parents to stay in the same room as their baby throughout their stay, which allows for more bonding time, and reduces risk of infection because each baby is in a different room o This could lead to reduced length of stay for the infant, as well as reduce the risk of post-partum depression for the mother from being separated from her baby o NICU babies have better recoveries with skin on skin contact, it has been shown to stabilized thermoregulatory and cardiovascular systems o Family involvement may help prevent medical errors, as well as provide nurses with the opportunity to work with the mother on how to care for the baby Serpero, L., Sabatini, M., Colivicchi, M., & Gazzolo, D. (2013). Rooming-in: An update. Early Human Development, 89(4), S12-S14.
Rooming-in for Elderly Surgical Patients
• Elderly patients undergoing surgery are prone to confusion, interventions may help reduce this • Patients who were admitted for surgery showed less signs of confusion if they had a family member rooming in with them after the surgery • This is especially helpful for patients undergoing unplanned emergency surgery Wells, N., & Baggs, J. (1997). Rooming-in for elderly surgical patients. Applied Nursing Research, 10(2), 72-79.
30
s n o i t a v r
e s b O
In October 2014 the fourth year Interior Design studio observed in the four cardiovascular wings of the old University of Kentucky hospital for a pre-occupancy evaluation. This evaluated nurse and tech paths of travel, as well as communication between staff members This information will be compared with the post occupancy study of the new cardiovascular unit opening December 2014. The second study will take place around August 2015.
31
n o i t a v bser
O t s a 6E
Getting to watch how nurses, doctors, and techs interacted within their environments helped me understand why what we are doing is so important, and how we can better design these spaces. In the patient room we mainly focused on patient and family design, but for the rest of the project we will have a larger opportunity to focus on the caregivers spaces. Seeing how they work is invaluable to the design process. Most of us have had experiences in hospital rooms as a patient or a family member, so we can relate to the patientâ&#x20AC;&#x2122;s experience. None of us have ever worked in a hospital, so to get the perspective of a caregiver is so helpful in the design process. Marrying the patient/family space with the caregiver space is a unique challenge, but I believe now that I have observed I can make educated decisions about the design. The observation will impact my design heavily in the hallways. Providing enough space for doctors and med students to meet in the hallway without creating a traffic jam will streamline the hallways. Creating an aesthetically pleasing walking path with help patients gain confidence in their walking right after surgery. Providing a walking path that avoids the open doors of other patient rooms, especially patients who are in poor condition will help keep their spirits up. This also supported my decision of creating decentralized nursing stations with a small central reception desk and additional station because of the amount of distance put between the nurses/techs and the patients. In 6 East, the nurse and tech stations are in converted patient rooms so they have no visibility to their patients. This resulted in long lag times between the call button and nurse response. Providing visibility and windows not just in patient rooms, but also in the corridors is a small thing that would make a huge impact. Sitting there from 8am to 12 pm it was hard to tell what time it was other than the small glow of light coming from the patientâ&#x20AC;&#x2122;s frosted window. I appreciate my spaces so much more now. I may complain about classrooms at UK, or studio space that is not the greatest, but none of problems with those spaces could compare to working for 12 hours in that grim hospital wing. I was so ready to leave after 4 hours, I could not imagine staying there all day. I was also surprised to see just how hard the techs worked. They checked on patients more frequently that the nurses did and were constantly running from room to room. I think its important to design a space for the techs to enjoy as well.
32
CTVIC
U Ob
serva
tion
Having the opportunity to observe in the ICU was very informative. The ICU is much different than 6 East where I had my first observation experience. It was actually much calmer, because they had one to two nurses per patient. The nurses were absolutely hilarious and you could tell they truly loved their job. This is really where I got to see collaboration among healthcare professionals. It is hard in the other wings because the nurses stations are inside converted patient rooms, but in the CVICU you are in the middle of the room with everyone. I found that the family members were very involved in the ICU and would come to talk to the nurses more than they did in 6 East. They nurses were always happy to hear them out which made me see at least a small example of a patient centered care model. Providing convenient spaces for these interactions to happen is very important. I also noticed that the nurses were in a centralized station the entire station ran parallel to patient rooms, which allowed nurses to be very close to their patients, but allowed for the collaboration and camaraderie of the nursing profession. I think I may want to implement this design in my clinic design. When talking to one of the nurses about moving over to the new hospital he was very upset. He said, “The designers didn’t involved nurses in the design process. That is apparent. I won’t be surprised if they have a large nurse walkout when we move over to 8.” I believe he was talking mainly about the decentralized nursing stations. I was really sad to hear that comment. I really would like to come up with a good solution that improves patient care while still allowing for the collaboration of the nursing profession. ICU was actually my favorite place to observe. Elizabeth and I were seated on the side of the nursing station, so that allowed us to be “in the trenches” with the nurses and their interactions first hand. It really is like a big crazy family. Their job is one of the most stressful jobs around, and it is imperative to have that camaraderie otherwise they would get very depressed. One minute they are talking about the 27 year old who has been on life support for two weeks, and the next they are joking that you should never decorate for Christmas in August because it makes people crazy. The patient who had just arrived from surgery decided to eat a string of Christmas lights at home, so the nurse had to ask for “friendship bracelets” which they explained to us were hand restraints because he was under psychiatric hold. These nurses we hilarious and truly needed each other to get through the day. I think sometimes I may overlook the impact that social support can have for a person, so 33 to me that will be a large focus of my next design.
n o i t a serv
b
O t s e 6W
Having the opportunity to see how people work and heal in a hospital environment is crucial to the understanding of healthcare design. In this particular wing, 6 West, I saw the effects of a break room on the nurses and techs of that wing. These were unfortunately not good effects. The nurses and techs spent a large majority of their time in the break room. Healthcare design is about a good balance between patient needs and employee needs, and unfortunately in this wing I felt that patient needs were not well met. The “hangout” space was a large distraction to caregivers and prevented patients from getting the high quality of care they needed. In 6 West, the nurses and techs spent the majority of their time in the break room rather than the nurse’s station. The tech stations were also in the break room, but only one of the two techs left the room on a frequent basis to help patients. On one occasion when she walked out she turned to us and said she was basically the only one working today because everyone else was glued to the TV. Often patient calls would go unanswered for a very long time while the staff was in the break room or the nurses station. The break room was at the very end of the hall on the left, close enough to patient rooms to make it a convenient landing spot, but separating caregivers from their patients. Because the nurses were spending so much time in the break room and the nurses’ station, family members of patients were forced to go seek out their nurse for care. Having decentralized stations with a view inside the room would help streamline this care system. Having clear sightlines would also help caregivers observe the patients firsthand. At one point a patient made a very loud, alarming sound, and instead of the nurses running straight inside the room to help, they stopped and had to ask Katy and me what room the sound came from. Luckily it was just a loud sneeze, but without visibility they were forced to waste time asking us which room the sound came from which could mean life or death in an emergency situation. I gained an appreciation for nurses that work hard and who’s main focus is the care of the patients instead of going on a Starbucks run, or what was on TV in the break room. I gained appreciation for the glass walls of the ICU which provided clear sightlines from the patients to the which allowed the patients to get a higher quality of care. I learned that unfortunately, like every profession, there are people who work very hard, and people who do not.
34
6 Eas
t Obs
ervati
on
As soon as we walked into 6 East on October 15, 2014 two code blue alarms went off. A code blue is when a patient is dying and a crash cart is used to try and revive them or stabilize them to move them to the ICU. This was one of the most terrifying experiences of my life. Nurses and doctors were coming from every hall, stair, and elevator in the surrounding area. A hallway that typically had 3 people in it suddenly had 20+ all yelling directions and running around to gather supplies. Location was so important in this experience, location of supplies, location of the crash cart, and location of caregivers. It is imperative that these supplies are all very close to the patients for quick response times in emergency situations. During the code blue nurses were running to supply rooms and were forced to stop and scan their badge at the door in order to enter. This act slowed them down considerably as some, as some who were in such a rush to gather the supplies, did not get their badge scanned the first time and were forced to waste more time during the second attempt. I would like to implement a system where nurses and doctors can simply walk up to a door and through remote sensing, the door will open for them, saving vital time. There was not enough room in the space for all the caregivers, the crash cart, and both patients who were in the room at the same time. The nurses were forced to move it in and out of the room which trying to care for the patient. Providing single occupancy rooms as well as having a crash cart in the room at all times would save time. I can only assume that the experience of sitting in the space while that was happening very traumatic to the patient. If each patient has their own room this would prevent traumatizing situations such as this. Providing a small quiet space for family members close to the patient rooms. The mother of the patient who was dying was forced to make phone calls in the hallway to family members without any privacy. Once they got the patient stable they were forced to run him all the way down the hallway to get him to an elevator to get him to the ICU. Watching this scene I gained appreciation for my line of work. Seeing the nurses and doctors trying to help someone through a life threatening emergency with such grace and calmness is so inspiring, but also shows me I could never handle that job. I could never imagine seeing trauma like that everyday. Like nursing, Interior Design focuses on the health, safety, and welfare of the user, but I am confident in saying that I will never ever have to revive someone while doing my job. While I will never directly care for a patient, I am glad to say that something I design could help another person save someoneâ&#x20AC;&#x2122;s life. 35
t n e d e Prec Founded in 1855 The Children’s Hospital of Philadelphia was the first hospital in the US to be devoted exclusively to pediatrics. Carrying on that tradition CHOP has committed itself to serving children and their families through research, education, and family centered care. The 480 bed hospital is part of the University City campus which contains CHOP, as well as a rehabilitation facility, and ambulatory care center, and over 800,000 square feet of research space. According to US News and World Report The Children’s Hospital of Philadelphia is ranked in the top four for the following pediatric specialties: Cancer, Cardiology and Heart Surgery, Diabetes and Endocrinology, Gastroenterology & GI Surgery, Neonatology, Nephrology, Neurology and Neurosurgery, Orthopedics, Pulmonology, and Urology. It is affiliated with the University of Philadelphia, and serves as a teaching hospital.
Mission
The Children’s Hospital of Philadelphia, the oldest hospital in the United States dedicated exclusively to pediatrics, strives to be the world leader in the advancement of healthcare for children by integrating excellent patient care, innovative research and quality professional education into all of its programs. Their mission is focused around 3 main areas: • Research • Family Centered Care • Education and Advocacy
36
CHOP focuses on positive distractions, and making the hospital environment more comfortable for children and their families. CHOP integrates technology into the caring process by incorporating point of care charting into their family centered care approach. They also incorporate fun, bright colors into their design. Their MRI machine is more approachable with its use of natural greens and browns and the innovative design which removes the tube that is a frightening part of the process for children. While their exterior, lobby, and technology are very successful, their patient rooms could use a redesign.
Prece
dent
Seattle Children’s Hospital architects utilized evidence based design research to create a space not only for children, but also for their families. This integrated approach allows the hospital to use Family Centered Care approaches. They provide large single-occupant rooms to provide families with the opportunity to support their child’s healing process in a way that is also comfortable to them. They also have dedicated family spaces outside of the room for a variety of rest and healing options. ZGF created spaces where families can store and prepare food, an innovation not often seen in healthcare settings.
ZGF knows the importance lighting can have to healing. They have installed a pre-set dimmable light fixture that mimics the body’s natural rhythms which has been shown to help with relaxation and sleep patterns. The addition of a color changing LED wall allows patients to customize their space, normally something very hard to do in a hospital environment. The large windows allow light to not only penetrate the patient room, but also to enliven the corridors and team cores. The thought and care placed on user experience and evidence based design is what makes Seattle Children’s Hospital an excellent example of healthcare design.
37
Patient and Family Centered Care
An innovative approach to the planning, delivery and evaluation of heal care grounded in mutually beneficial partnerships among health care providers, patients, and families.
38
g n i m m a
r g Pro
Programming Project Goals Client Analysis User Analysis Site Analysis Spatial Needs Diagrammatic Analysis Preliminary Design Considerations Code Issues
39
Goals how do we create a touchpoint?
1
provide a space for patients that supports healing and more productive hospital stays by utilizing positive distractions, and patient customization
3
utilize technology to improve the healing process by increasing caregiver efficiency, and providing patients with positive distractions
create a streamlined space for caregivers that increases efficiency and reduces mistakes which allows for shorter, more productive length of stays as well as reducing healthcare associated infections
sitive di po s
e
ate
o
lo
int
gy
reduced length of stay
gr
40
increa s
efficiency ed
ctions a r t
d techn
2
t n e i l C
r e s U and
s i s y l Ana
The client and user analysis provides designers with vital information on the client and the user, that they then use to design a building unique to their wants and needs.
41
s
si y l a n ser A
U
Patients
Pediatric patients range from age 0 to 18. These patients have just arrived in this recovery unit after having cardiac surgery. The patients are mostly very anxious about the surgery they are about to undergo, as well as being in an unfamiliar environment. The chart below illustrates the average hospital stay for a pediatric cardiology patient.
how long is the average hospital stay? common procedures
atrial septal defect repair ventricular septal defect repair coarctation of the aorta repair complete atrio-ventricular septal defect tetralogy of fallot repair transposition of the great arteries heart transplant
3 4 4 6 6 11 12
average length of stay (days)
Family
In pediatrics, family is considered a vital element in the patientâ&#x20AC;&#x2122;s recovery process. The family of a patient will be experiencing high anxiety and stress. It is important to make the family feel comfortable as well as supported so they are better able to make vital decisions about their patient. One or more family members will most likely stay overnight in their patientâ&#x20AC;&#x2122;s room. The following are considered family members: Mothers, Fathers, Brothers, Sisters, Grandparents, Aunts and Uncles, Close Friends
Caregivers The large age range of pediatrics, combined with the many types of cardiac diseases creates unique challenges for caregivers. In this cardiac recovery clinic, patients have just arrived after having cardiac surgery. These caregivers will support critically ill patients, as well as those ready to go home. The following are considered caregivers: Doctors, Nurse Practitioners, Registered Nurses, Nurse Technicians, Radiology Staff
Hospital Support Staff
The hospital support staff are employees of the hospital that are imperative to hospital operations, but are not directly associated with patient care. The following are considered Support Staff: Housekeeping, Custodians, Operation Managers, Food Service Employees, Receptionists, Schedulers, Physical Therapists, Occupational Therapists, Social Workers, Patient Relation Assistants, etc.
42
Client
Analy
sis
Washington University’s mission is to discover and disseminate knowledge, and protect the freedom of inquiry through research, teaching, and learning. Washington University creates an environment to encourage and support an ethos of wide-ranging exploration. Washington University’s faculty and staff strive to enhance the lives and livelihoods of students, the people of the greater St. Louis community, the country, and the world.
Goals
St. Louis, Missouri
• To welcome students, faculty, and staff from all backgrounds to create an inclusive community that is welcoming, nurturing, and intellectually rigorous; • to foster excellence in our teaching, research, scholarship, and service; • to prepare students with attitudes, skills, and habits of lifelong learning and leadership thereby enabling them to be productive members of a global society; and • to be an institution that excels by its accomplishments in our home community, St. Louis, as well as in the nation and the world.
Student Population Social Work & Public Health 701 Other 153
Architecture 177 Art 270
Architecture 322
Engineering 1,301 Part Time & Other 827 Business 860
Art 51 Medicine 1,928
Undergraduate Student Population 7,331
Graduate Student Population 6,959 Law 836
Arts & Sciences 3,899
Arts & Sciences 840
Business 1,226 Engineering 902
Washington University Medical Center
1,573 Beds
•Washington University • Alvin J. Siteman Cancer Center • Barnes-Jewish Hospital • St. Louis Children’s Hospital • The Rehabilitation Institute of St. Louis
43
Site
s i s y l Ana
The site analysis gives information about the existing conditions, as well as the demographics of the area. The site is located at: University Medical Center 4401 Clayton Avenue St. Louis, Missouri 63110.
St. Louis The Site
Missouri
St. Louis
The Site
44
Demo
graph
ics
Determining demographics of the location is important to the design. This allows the design to be customized to the culture and needs of the surrounding area. All information was retrieved from the 2010 U.S. Census. St. Louis, Missouri has a population of approximately 318,416. The median household income is $34,384. 27% of residents live below the poverty line. Below are two graphs that show the ages and races of the population (Census 2014).
Black or African American 49.2%
5-18 Years 21.2%
0-5 Years 6.6%
Native American or Native Alaskan 0.3% Asian 2.9% Hispanic or Latino 3.5%
Age
Race
65 Years + 11%
19-64 Years 61.2%
e t a m i Cl
White 43.9%
Season
Average High
Vernal Equinox March 20 Summer Solstice June 21 Autumnal Equinox September 22 Winter Solstice December 21
55°F 85°F 81°F 43°F
Average Average Low Precipitation 37°F 67°F 61°F 28°F
3.36 in. 4.34 in. 3.38 in. 2.96 in.
45
s i s y l a e An
n i L t h Sig
Information about the sight lines on the building location will provide designers with a road map detailing where spaces need to be located in the building.
New
stea
d Av
Clayton Ave
e
North View Bio-Tech Lab
West View Wash U Human Resources
W
N S
East View Stix Childhood Center
E
South View I-64
46
Sun S
tudy
Determining the location of the sun will allow the designer to lay out the space in a way that takes advantage of the natural light of the sun. Each circle represents the start of a season and where the sun is located. The red marker represents the site location Each line represents the location of the sun at a specific time, and where it is hitting the building. Yellow is the sun at sunrise. Orange is the sun at noon. Coral is the sun at sunset.
Autumnal Equinox: September 22
Winter Solstice: December 21
Vernal Equinox: March 20
Summer Solstice: June 21
47
s d e l Ne
a i t a Sp
Determining the spatial needs of rooms, as well as equipment determines how much square footage a project will need to be successful.
48
Spatia
l Nee
Primary Areas
Area Elevators and Stairs Patient Rooms
Quantity
SF/unit 2 14
Meds Room Supplies Room Family Respite Areas Work Stations (Decentralized) Centralized Work Station Greeter Circulation
NSF 500 306
1 200 1 260 2 1-1,000 1-200 14 10 1 200 1 130 20%
ds
Comments 1,000 Access to main pathways 4,284 Patient bed, handwashing station, ADA bathroom, storage, table, sleeper sofa, headwall with equipment 200 Medication, secure access 260 Supplies, secure access 1,200 Sofas, chairs, coffee, tables, writing surface 80 Writing surface, monitor(s), chair 200 Writing surface, monitor(s), chair 130 Desk, Phone, Monitor 3,208
Support Areas Staff Break Room+Lockers
1
500
Clean Utility Room Soiled Utility Room
1 1
260 300
Classroom/Conference Room Staff Restrooms Public Restrooms Portable Equipment Alcoves Rec/Rehab Room Nourishment Stations Consultation Rooms
1 2 2 8 1 1 2
315 100 100 6 250 125 175
500 Lockers, refrigerator, sink, microwave, coffee, and table with seating for 8 260 Clean Linens, linen cart 300 Bio-hazard waste disposal, Trash, Soiled Linen Hamper, Handwash Sing, Countertop, Clinical Sink 315 Seating for 12-16 200 Unisex, confirm plumbing fixture count per code 200 Confirm plumbing count per code. 48 Part of Hallway, Next to patient rooms, out of direct traffic 250 Rehab equipment, 4 chairs 125 Sink, refrigerator, ice machine 350
1
215
215 Desk, chair, file cabinet, and 2 guest chairs
Administrative Areas Patient Care Manager Office
t
n e m p Equi
The following is a list of equipment used in the Cardiovascular Unit of hospitals: Cardiac Monitors Cardiac Ultrasound Machines Crash Cart Defibrillator Echocardiogram Machine (EKG) Extra-corporeal Membrane Oxygenation Machine (ECMO) Heart-Lung Bypass Machines Medical Gas Medical Air Infusion Pumps Intra-Aortic Balloon Pumps IV Pole Portable Charting Device Portable MRI Stress Test Systems Vascular Doppler Vital Sign Monitor
49
ic t a m gram
Dia
50
s i s y l Ana
The following diagrams provide information on spatial needs, as well as help determine access and adjacency information.
Adjac
ency
Matri
x
An adjacency matrix is a tool for designers to utilize while space planning. It provides information on what spaces need to be next to each other, and which do not.
Elevators and Stairs Patient Rooms Workstations Staff Break Room Meds Rooms Supplies Room Clean Utility Room Soiled Utility Room Classroom/Conference Room Staff Restrooms Public Restrooms Portable Equipment Alcoves Nourishment Station Family Respite Areas Rec/Rehab Room Patient Care Manager Office
Required Adjacency Preferred Adjacency No Adjacency Required
51
x
A criteria matrix is a tool designers use to determine what aspects are needed or not needed for each space. This matrix play a large role in the space planning portion of the project.
Elevators and Stairs Patient Rooms Workstations Staff Break Rooms and Lockers Meds Rooms Supplies Rooms Clean Utility Rooms Soiled Utility Rooms Classroom/Conference Room Staff Restrooms Public Restrooms Portable Equipment Alcoves Nourishment Stations Family Respite Areas Rec/Rehab Room Patient Care Manager Office
Natural Light Varied Light View In View Out Patient Use Staff Use Calming Colors Acoustical Privacy Visual Privacy Harsh Cleaning Antimicrobial Products Security (Badge Entry) Positive Distractions Integrated Technology
ri t a M ia r e t i r C
Needed
52
Indifferent
Not Needed
Acces
s Diag
ram
A hospital can be a chaotic, stressful environment. Determining who has access to hospital spaces will provide a road map for wayfinding, signage, as well as security. This will help reduce anxiety and determine “front stage” and “back stage” areas which will help staff in the caregiving process.
Staff Access
Patient Access
Meds Room Supplies Room Work Stations Break and Locker Room Clean Utility Room Soiled Utility Room Classroom/Conference Room Patient Care Manager Office Portable Equipment Alcoves Elevators and Stairs Patient Rooms Family Respite Areas Public Restrooms Rec/Rehab Room
Visitor Access
53
y
r a n i m Preli
s n o i t idera
s
n o C n Desig
These preliminary design considerations are the beginning of the aesthetic design of the project.
54
color palette.
lighting plan.
Providing a variety of lighting styles and options gives the patient the opportunity to easily customize their healing environment. Three factors create an interactive, user friendly lighting plan. anging lig ch
colo r
na
gener a
al lightin g tur
ing ht
The cool blues and greens create a soothing environment which supports the natural healing process. The greens provide a refreshing atmosphere, as well as promote healing, while the blues offer serenity while calming and soothing the spirit (Allan Novak and Richardson 2013).
ing ht
nd task lig la
First, the general and task lighting provides light for all users activities and needs. Second, the windows provide the way for natural sunlight to penetrate the room, and bring nature into the healing environment. And finally, with the help of LED light strips, users can chose colors around the footwall, and on the fixture above for a cool, customizable atmosphere.
furniture/materials These vinyl upholsteries manufactured by Standard Textiles are utilized in the the built in seating for their excellent abrasion resistant properties.
This solid surface countertop by EOS is infused with copper, increasing its antimicrobial properties exponentially.
Vibe by Knoll was used on the sofa because of its antimicrobial, bleach cleanable surface created from a combination of polyurethane and polyester.
This vinyl sheet flooring by Armstrong is gouge and abrasion resistant, as well as having excellent static load resistance, UV coating, and aseptic qualities. This flooring by Altro is excellent for bathroom use, because of its slip resistant surface in both wet and dry applications.
E-Tenz by Steelcase was used in the family area because when fully opened can sleep two people comfortably.
55
s e u s s I e d
Co
The following information outlines codes in regards to ADA specifications, signage, building component codes, and lighting and material codes.
56
ADA
Speci
ficatio
ns
The following ADA Specifications are outlined in the Department of Justiceâ&#x20AC;&#x2122;s 2010 ADA Standards for Accessible Design. They set the standards for accessible design. In this section you will find information on the following: Turning Radius .................... 57 Toe Clearance .................... 57 Knee Clearance ................. 58 Protruding Objects ........... 58 Reach Range ..................... 59 Hallway Width .................... 59 Door Hardware .................. 61
Elevators ............................ 63 Hall Signals ........................ 63 Stairways ............................ 64 Handrails ............................ 64 Water Closets ..................... 65 Shower Compartments ..... 67 Signs ................................... 68
57
s n o i t a ecific
Sp A D A
58
ADA
Speci
ficatio
ns
59
s n o i t a ecific
Sp A D A
60
ADA
Speci
ficatio
ns
61
s n o i t a ecific
Sp A D A
62
ADA
Speci
ficatio
ns
63
s n o i t a ecific
Sp A D A
64
ADA
Speci
ficatio
ns
65
s n o i t a ecific
Sp A D A
66
ADA
Speci
ficatio
ns
67
s n o i t a ecific
Sp A D A
68
ADA
Speci
ficatio
ns
69
e
g Signa
Exit Signs
Exit signs are required by the International Building Code (Winkel 2007). IBC 1011.1 states: “Exit signs must be provided at exits and exit access doors. • Exit signs must be of an approved design, be illuminated by internal or external means, and have the capability to remain illuminated for up to 90 minutes by either battery, internal illumination, or connection to an emergency power source. • Exit signs must be clearly visible and be not more that 100’ (30 480) from any point in an exit access corridor. • Tactile exit signs accessible for persons with disabilities are to be provided at doors to egress stairways, exit passageways, and the exit discharge.”
Accessible Signage Logos
“1110.1 requires the international symbol of accessibility to be located at accessible parking spaces per 1106.1, accessible areas of refuge per 1007.6 , at accessible toilet locations, at accessible entries, accessible checkout aisles, and at accessible dressing and accessible locker rooms. The ADAAG requires permanent room signage to be located in a prescribed location. Signs are also to have tactile raised lettering and Braille symbols. (see ADA requirements)
Directional Signage
Where not all elements are accessible, 1110.2 requires there be signage to direct people with disabilities to the nearest accessible element. These signs must have the international sign of accessibility.”
Other Signs
When special access provisions are made, then 1110.3 requires signage to be provided to highlight those provisions. The specific requirements are: 1. When assistive listening devices are provided per 1108.2.6, signs to that effect are to be provided at ticket offices or similar locations. 2. Each door to an exit stairway is to have a sign in accordance with 1011.3. This section requires a tactile exit sign complying with A117.1. 3. At areas of refuge and areas for assisted rescue signage shall be provided in accordance with 1007.6.3 through 1007.6.5. 4. At areas for assisted rescue signage is to be provided per 1007.8.3.
70
Inte
l a n o i rnat
e d o C g n i d l i Bu
International Building Code 2012 Occupancy Classification Code According to the International Building Code 308.4 and the Kentucky Building Code 115.1 this clinic will be defined as an:
Institutional Group I-2.
â&#x20AC;&#x153;This occupancy shall include buildings and structures used for medical care on a 24-hour basis for more than five persons who are incapable of self-preservation. This group shall include, but not be limited to, the following: Foster care facilities Detoxification facilities, Hospitals, Nursing homes, Psychiatric hospitalsâ&#x20AC;&#x153; (IBC 2012) It is necessary to define the clinic to follow the specified codes for this type of project. The following information are codes that I-2 classified spaces must comply with according to the Kentucky Building Code and outlined in the 2012 International Building Code.
71
e and ts s U d n le Detai Requireme ancy p u c c O
IBC 407.2 Corridors Continuity and Community Separation
Corridors in occupancies in Group I-2 shall be continuous to the exits and shall be separated from other areas in accordance with Section 407.3 (Corridor walls shall be constructed as smoke partitions in accordance with Section 710)except spaces conforming to Sections 407.2.1 (Waiting and similar areas), 407.2.2 (Care provider’s stations), through 407.2.4.
407.2.1 Waiting and similar areas.
Waiting areas and similar spaces constructed as required for corridors shall be permitted to be open to a corridor, only where all of the following criteria are met: 1. The spaces are not occupied as care recipient’s sleeping rooms, treatment rooms, incidental uses in accordance with Section 509, or hazardous uses. 2. The open space is protected by an automatic fire detection system installed in accordance with Section 907. 3. The corridors onto which the spaces open, in the same smoke compartment, are protected by an automatic fire detection system installed in accordance with Section 907, or the smoke compartment in which the spaces are located is equipped throughout with quick-response sprinklers in accordance with Section 903.3.2. 4. The space is arranged so as not to obstruct access to the required exits
407.2.2 Care providers’ stations.
Spaces for care providers’, supervisory staff, doctors’ and nurses’ charting, communications and related clerical areas shall be permitted to be open to the corridor, where such spaces are constructed as required for corridors.
407.4 Means of egress.
Group I-2 occupancies shall be provided with means of egress complying with Chapter 10 and Sections 407.4.1 through 407.4.3.
407.4.1 Direct access to a corridor.
Habitable rooms in Group I-2 occupancies shall have an exit access door leading directly to a corridor. Exceptions: 1. Rooms with exit doors opening directly to the outside at ground level. 2. Rooms arranged as care suites complying with Section 407.4.3.
407.4.2 Travel distance.
The travel distance between any point in a Group I-2 occupancy sleeping room and an exit access door in that room shall be not greater than 50 feet (15 240 mm).
407.5 Smoke barriers.
Smoke barriers shall be provided to subdivide every story used by persons receiving care, treatment or sleeping and to divide other stories with an occupant load of 50 or more persons, into no fewer than two smoke compartments. Such stories shall be divided into smoke compartments with an area of not more than 22,500 square feet (2092 m2) and the travel distance from any point in a smoke compartment to a smoke barrier door shall be not greater than 200 feet (60 960 mm). The smoke barrier shall be in accordance with Section 709.
72
407.6 Automatic sprinkler system.
Det Occup ailed Use an ancy R equire d ments
Smoke compartments containing sleeping rooms shall be equipped throughout with an automatic fire sprinkler system in accordance with Sections 903.3.1.1 and 903.3.2.
903.3.1.1 NFPA 13 sprinkler systems.
Where the provisions of this code require that a building or portion thereof be equipped throughout with an automatic sprinkler system in accordance with this section, sprinklers shall be installed throughout in accordance with NFPA 13 except as provided in Section 903.3.1.1.1.
903.3.2 Quick-response and residential sprinklers.
Where automatic sprinkler systems are required by this code, quick-response or residential automatic sprinklers shall be installed in the following areas in accordance with Section 903.3.1 and their listings: 1. Throughout all spaces within a smoke compartment containing care recipient sleeping units in Group I-2 in accordance with this code. 2. Throughout all spaces within a smoke compartment containing treatment rooms in ambulatory care facilities. 3. Dwelling units and sleeping units in Group I-1 and R occupancies. 4. Light-hazard occupancies as defined in NFPA 13.
407.7 Fire alarm system.
A fire alarm system shall be provided in accordance with Section 907.2.6.
907.2.6 Group I.
A manual fire alarm system that activates the occupant notification system in accordance with Section 907.5 shall be installed in Group I occupancies. An automatic smoke detection system that activates the occupant notification system in accordance with Section 907.5 shall be provided in accordance with Sections 907.2.6.1, 907.2.6.2 and 907.2.6.3.3. Exceptions: 1. Manual fire alarm boxes in sleeping units of Group I-1 and I-2 occupancies shall not be required at exits if located at all care providersâ&#x20AC;&#x2122; control stations or other constantly attended staff locations, provided such stations are visible and continuously accessible and that travel distances required in Section 907.4.2.1 are not exceeded. 2. Occupant notification systems are not required to be activated where private mode signaling installed in accordance with NFPA 72 is approved by the fire code official.
907.5 Occupant notification systems.
A fire alarm system shall annunciate at the fire alarm control unit and shall initiate occupant notification upon activation, in accordance with Sections 907.5.1 through 907.5.2.3.4. Where a fire alarm system is required by another section of this code, it shall be activated by: 1. Automatic fire detectors. 2. Automatic sprinkler system water flow devices. 3. Manual fire alarm boxes. 4. Automatic fire-extinguishing systems.
73
ls a i r e t r Ma
rio Inte801.1 Scope.
Provisions of this chapter shall govern the use of materials used as interior finishes, trim and decorative materials.
801.2 Interior wall and ceiling finish.
The provisions of Section 803 shall limit the allowable fire performance and smoke development of interior wall and ceiling finish materials based on occupancy classification.
801.3 Interior floor finish.
The provisions of Section 804 shall limit the allowable fire performance of interior floor finish materials based on occupancy classification.
801.4 Decorative materials and trim.
Decorative materials and trim shall be restricted by combustibility and the flame propagation performance criteria of NFPA 701, in accordance with Section 806.
801.5 Applicability.
For buildings in flood hazard areas as established in Section 1612.3, interior finishes, trim and decorative materials below the elevation required by Section 1612 shall be flood-damageresistant materials.
801.6 Application.
Combustible materials shall be permitted to be used as finish for walls, ceilings, floors and other interior surfaces of buildings.
801.7 Windows.
Show windows in the exterior walls of the first story above grade plane shall be permitted to be of wood or of unprotected metal framing.
801.8 Foam plastics.
Foam plastics shall not be used as interior finish except as provided in Section 803.4. Foam plastics shall not be used as interior trim except as provided in Section 806.3 or 2604.2. This section shall apply both to exposed foam plastics and to foam plastics used in conjunction with a textile or vinyl facing or cover.
SECTION 803 INTERIOR WALL AND CEILING FINISH 803.1 General.
Interior wall and ceiling finish materials shall be classified for fire performance and smoke development in accordance with Section 803.1.1 or 803.1.2, except as shown in Sections 803.2 through 803.13. Materials tested in accordance with Section 803.1.2 shall not be required to be tested in accordance with Section 803.1.1.
803.7 Expanded vinyl wall coverings.
Where used as interior wall finish materials, expanded vinyl wall coverings shall be tested in the manner intended for use, using the product mounting system, including adhesive, and shall comply with the requirements of Section 803.1.2, 803.1.3 or 803.1.4.
74
Interi
or Ma
SECTION 804 INTERIOR FLOOR FINISH 804.1 General.
terials
Interior floor finish and floor covering materials shall comply with Sections 804.2 through 804.4.2. Exception: Floor finishes and coverings of a traditional type, such as wood, vinyl, linoleum or terrazzo, and resilient floor covering materials that are not comprised of fibers.
804.2 Classification.
Interior floor finish and floor covering materials required by Section 804.4.2 to be of Class I or II materials shall be classified in accordance with NFPA 253. The classification referred to herein corresponds to the classifications determined by NFPA 253 as follows: Class I, 0.45 watts/cm2 or greater; Class II, 0.22 watts/cm2 or greater.
804.3 Testing and identification.
Interior floor finish and floor covering materials shall be tested by an agency in accordance with NFPA 253 and identified by a hang tag or other suitable method so as to identify the manufacturer or supplier and style, and shall indicate the interior floor finish or floor covering classification according to Section 804.2. Carpet-type floor coverings shall be tested as proposed for use, including underlayment. Test reports confirming the information provided in the manufacturer’s product identification shall be furnished to the building official upon request.
804.4 Interior floor finish requirements.
Interior floor covering materials shall comply with Sections 804.4.1 and 804.4.2 and interior floor finish materials shall comply with Section 804.4.2.
804.4.1 Test requirement.
In all occupancies, interior floor covering materials shall comply with the requirements of the DOC FF-1 “pill test” (CPSC 16 CFR Part 1630) or with ASTM D 2859.
804.4.2 Minimum critical radiant flux.
In all occupancies, interior floor finish and floor covering materials in enclosures for stairways and ramps, exit passageways, corridors and rooms or spaces not separated from corridors by partitions extending from the floor to the underside of the ceiling shall withstand a minimum critical radiant flux. The minimum critical radiant flux shall not be less than Class I in Groups I-1, I-2 and I-3 and not less than Class II in Groups A, B, E, H, I- 4, M, R-1, R-2 and S. Exception: Where a building is equipped throughout with an automatic sprinkler system in accordance with Section 903.3.1.1 or 903.3.1.2, Class II materials are permitted in any area where Class I materials are required, and materials complying with DOC FF-1 “pill test” (CPSC 16 CFR Part 1630) or with ASTM D 2859 are permitted in any area where Class II materials are required.
75
ls a i r e t r Ma
rio InteSECTION 808 ACOUSTICAL CEILING SYSTEMS 808.1 Acoustical ceiling systems.
The quality, design, fabrication and erection of metal suspension systems for acoustical tile and lay-in panel ceilings in buildings or structures shall conform with generally accepted engineering practice, the provisions of this chapter and other applicable requirements of this code.
808.1.1 Materials and installation.
Acoustical materials complying with the interior finish requirements of Section 803 shall be installed in accordance with the manufacturerâ&#x20AC;&#x2122;s recommendations and applicable provisions for applying interior finish.
808.1.1.1 Suspended acoustical ceilings.
Suspended acoustical ceiling systems shall be installed in accordance with the provisions of ASTM C 635 and ASTM C 636.
808.1.1.2 Fire-resistance-rated construction.
Acoustical ceiling systems that are part of fire-resistance-rated construction shall be installed in the same manner used in the assembly tested and shall comply with the provisions of Chapter 7.
SECTION 1205 LIGHTING 1205.1 General.
Every space intended for human occupancy shall be provided with natural light by means of exterior glazed openings in accordance with Section 1205.2 or shall be provided with artificial light in accordance with Section 1205.3. Exterior glazed openings shall open directly onto a public way or onto a yard or court in accordance with Section 1206.
1205.2 Natural light.
The minimum net glazed area shall be not less than 8 percent of the floor area of the room served.
1205.2.1 Adjoining spaces.
For the purpose of natural lighting, any room is permitted to be considered as a portion of an adjoining room where one-half of the area of the common wall is open and unobstructed and provides an opening of not less than one-tenth of the floor area of the interior room or 25 square feet (2.32 m2), whichever is greater. Exception: Openings required for natural light shall be permitted to open into a sun room with thermal isolation or a patio cover where the common wall provides a glazed area of not less than one-tenth of the floor area of the interior room or 20 square feet (1.86 m2), whichever is greater.
1205.2.2 Exterior openings.
Exterior openings required by Section 1205.2 for natural light shall open directly onto a public way, yard or court, as set forth in Section 1206. Exceptions: 1. Required exterior openings are permitted to open into a roofed porch where the porch: 1.1. Abuts a public way, yard or court; 1.2. Has a ceiling height of not less than 7 feet (2134 mm); and 1.3. Has a longer side at least 65 percent open and unobstructed. 2. Skylights are not required to open directly onto a public way, yard or court.
76
Lighti
ng
SECTION 1205 LIGHTING 1205.3 Artificial light.
Artificial light shall be provided that is adequate to provide an average illumination of 10 footcandles (107 lux) over the area of the room at a height of 30 inches (762 mm) above the floor level.
1205.4 Stairway illumination.
Stairways within dwelling units and exterior stairways serving a dwelling unit shall have an illumination level on tread runs of not less than 1 footcandle (11 lux). Stairs in other occupancies shall be governed by Chapter 10.
1205.4.1 Controls.
The control for activation of the required stairway lighting shall be in accordance with NFPA 70.
1205.5 Emergency egress lighting.
The means of egress shall be illuminated in accordance with Section 1006.1.
77
Patient and Family Centered Care
An innovative approach to the planning, delivery and evaluation of heal care grounded in mutually beneficial partnerships among health care providers, patients, and families.
78
t n e lopm
e c n Co
e v e pt D
Clinic Logo Branded Wayfinding Package Visual Anthropology
79
o
g o L c i n Cli
The jumping movement of a frog inspired the green dots which demonstrate the journey of the patient from arriving at the clinic, revitializing within, and finally being released. When speaking of the entire clinic the green bar will say “at washington university.” When speaking of the individual unit it will say “pediatric cardiology unit.”
touchpoint at washington university
arrive
80
revitalize
release
Wayfi nd
ing Pa
ckage
cardiac unit
waiting area
Overhead signs will be plexiglass with an LED light strip at the top to bring attention to themselves without distracting too much from the surroundings. This will allow for maximum visibility in the evening when the overhead lights are dimmed.
cardiac unit
3
Clearly marked elevators will help users quickly determine where they are within the hospital.
Information â&#x20AC;&#x153;touchpointsâ&#x20AC;? will be located on the corners of the hallways and will be interactive. This will allow information to constantly be updated as well as provide a positive distraction for patrons.
320 Hannah Kelly Physician Dr. Smith Age: 9 Heart Rate: 70-135 bpm
314
Interactive nameplates will be placed directly outside of the patients door, and will keep nurses and caregivers up to date on the patients heart beat and other vital information. This will help avoid unnecessary interruptions from caregivers.
Supplies
81
l
Visua
y g o l o op r h t n A
A visual anthropology helps to create a sense of the space through inspirational imagery.
home.
The feeling of home is an integral part of the healing process. Providing this feeling for patients as well as family creates a relaxing environment. If the hospital environment can feel more like home, it can lower anxiety and stress, allowing family members can make better decisions about the care of their patients. In a home like environment patients are better able to relax and focus their energy on healing and rest.
nature.
Nature scenes provide a connection to the healing power of the natural world. The color scheme is derived from the natural blues and greens found in the exterior environment. Nature has been proven to reduce stress and anxiety and speed up the healing process. Creating an interior environment that is inspired by the exterior environment will provide a space that supports the healing process.
technology.
Incorporating technology in the healing process can provide positive distractions for patients and families. Interactive walls can help with wayfinding as well as provide an ever-changing environment for the staff who spend every day in the space. Technology can also increase caregiver efficiency by allowing information to be accessible the moment it is entered into the computer.
82
83
Touchpoint Pediatric Cardiology Unit
Pediatric cardiology patients spend a relatively short amount of time in the hospital environment. It is imperative to design spaces that promote high quality of care while reducing or preventing extended length of stay.
84
n g i s De
n o i t u l o S
Floor Plan Sections Renders
85
n
la P r o o Fl
Conference Room
Office
Family Respite Area
Greeter Large Consultation Room
Rehab Room
Staff Restroom
Public Restrooms Clean Utility
Nourishment Station
Meds Room
Supply Room
Central Nursing Station
Patient Room
Decentralized Nursing Station
Soiled Utility
Staff Restroom
Small Consultation Family Respite Area
86
Break Room
Sectio
ns
The floor plan and sections are color blocked to show the touchpoints for each user group.
patient
family
caregivers
support staff
87
entry
Features
direct access from main stairs greeter glowing countertops for wayfinding
88
family respite area Features
natural light views of nature movable furniture seating clusters interactive walls images of nature
89
decentralized station Features
view into patient room sliding door glass break away door wayfinding touchpoints defining soffits close access to respite areas curtain wall providing natural light same-handed rooms
90
patient room Features
process touchpoints curved cocoon headwall interactive monitor bench seating two person sleeper sofa views of nature bedside charting space handwashing touchpoint
91
central nursing station Features
information touchpoints central collaboration station glowing countertops for wayfinding direct access to meds, supplies, and nourishment central access to the corridors
92
break room
Features
comfortable seating views of nature interactive patient monitor lockers
93
managerâ&#x20AC;&#x2122;s office Features
close access to main stairs close access to caregiver core views of nature additional seating for meetings
94
conference room Features
direct access from main stairs modular tables classroom views of nature
95
y h p a r g o i l b i B
Abraham, M., & Ginn Moretz, J. (2012). Implementing patient- and family-centered care: Part I – understanding the challenges. Pediatric Nursing, 38(1), 44-47. Allan-Novak, C., & Richardson, B. (2013, December 1). Functional Color and Design in Healthcare Environments. Retrieved September 10, 2014, from http://continuingeducation.construction.com/article.php?L=222&C=928&P=1 Alkazemi, M., & Bayramzadeh, S. (2014). Centralized vs. decentralized nursing stations: An evaluation of the implications of communication technologies in healthcare. Health Environments Research & Design Journal, 7(4), 64-80. Bernhofer, E. (2013). Better use of lighting in hospital rooms may improve patients’ health. Journal of Advanced Nursing, 70(5), 1164-1173. Retrieved September 3, 2014, from Wiley Online Library. Bromley, E. (2012). Building patient-centeredness: Hospital design as an interpretive act. Social Science & Medicine, 75(6), 1057-1066. Retrieved September 6, 2014, from http://www.sciencedirect.com/science/article/pii/S0277953612004054 Bunker-Hellmich, L., Morelli, A., O’Neill, M., & Zborowsky, T. (2010). Centralized vs. decentralized nursing stations: Effects on nurses’ functional use of space and work environment. Health Environments Research & Design Journal, 3(4), 148-157. Choudhary, R., Joseph, A., Quan, X., Ulrich, R., & Zimring, C. (2004). Role of the physical environment in the hospital of the 21st century. Retrieved September 9, 2014, from https://www.healthdesign.org/chd/research/role-physical-environment-hospi tal-21st-century Department of Justice. 2010 ADA Standards for Accessible Design. (2010, September 15). Retrieved October 18, 2014, from http://www.ada.gov/ regs2010/2010ADAStandards/2010ADAstandards.htm Duffy, W., Kharasch, M., & Du, H. (2010). Point of care documentation impact on the nurse-patient interaction. Nursing Administration Quarterly, 34(1), E1-E10. Retrieved September 8, 2014, from OvidSP. Gurascio-Howard, L., & Malloch, K. (2007). Centralized and decentralized nurse station design: An examination of caregiver communication, work activities, and technology. Health Environments Research and Design Journal, 1(1), 45-57. Hua, Y., Becker, F., Wurmser, T., Bliss-Holtz, J., & Hedges, C. (2012). Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. Health Environments Research & Design Journal, 6(1), 8-38 Innovative system offers new way to track hand-washing compliance and prevent the spread of hospital infections. (2013, June 23). Retrieved September 8, 2014, from http://www.ssmhealth.com/news/biovigil_ssm_st_mary/
96
Biblio
graph
y
Magill, S., Edwards, J., et al. (2014). Multistate point-prevalence survey of health care– associated infections. New England Journal of Medicine, 370(13), 1198-1208. Retrieved September 10, 2014, from New England Journal of Medicine. McCullough, C., & Stichler, J. (2012). Same-handed patient room configurations: Anecdotal and empirical evidence. Journal of Nursing Administration, 43(3), 125-130. Retrieved September 1, 2014, from OvidSP. Meltzer, L., Finn Davis, K., & Mindell, J. (2012). Patient and parent sleep in a children’s hospital. Pediatric Nursing, 38(2), 64-71. Pandolph, P., & Joyce, L. (2001). One Stop Post Op cardiac surgery recovery--a proven success. The Journal of Cardiovascular Management, 12(5), 8-16. Retrieved October 4, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/11596524?report=abstract Pati, D. (2010, March 11). Positive Distractions. Retrieved September 5, 2014, from http://www.healthcaredesignmagazine.com/article/positive-distractions Pittet, D. (2000). Improving compliance with hand hygiene in hospitals. Infection Control and Hospital Epidemiology, 21(6), 381-386. Retrieved September 6, 2014, from http://www.jstor.org/stable/10.1086/501777 Scott-Allen, J., Hileman, K., & Ward, A. (2013, March 1). Simple solutions for improving patient safety in cardiac monitoring— eight critical elements to monitor alarm competency. Retrieved September 11, 2014, from http://www.aami.org/htsi/SI_Series/Alarm_Competency_White_Paper.pdf Serpero, L., Sabatini, M., Colivicchi, M., & Gazzolo, D. (2013). Rooming-in: An update. Early Human Development, 89(4), S12-S14. Steinburg, J., Denham, M., Zimring, C., & Et al. (2013). The role of the hospital environment the prevention of healthcare-associated infections by contact transmission. Health Environments Research & Design Journal, 7, 46-73. Retrieved September 4, 2014, from https://www.herdjournal.com/article/role-hospitalenvironment-prevention-healthcare-associated-infections-contact-transmission Stichler, J. (2014). Facility design and healthcare-acquired infections: State of the science. Journal of Nursing Administration, 44(3), 129-132. Retrieved September 5, 2014, from OvidSP. United States Census Bureau. (2014, July 8). Retrieved October 20, 2014, from http://quickfacts. census.gov/qfd/states/29/2965000.html Wells, N., & Baggs, J. (1997). Rooming-in for elderly surgical patients. Applied Nursing Research, 10(2), 72-79. Winkel, S., & Collins, D. (2007). Building codes illustrated for healthcare facilities: A guide to understanding the 2006 International building code for healthcare facilities. Hoboken, N.J.: Wiley.
97